title: Impact of an acute care surgery model on appendicectomy outcomes.
abstract: BACKGROUND
  Monash Medical Centre introduced the acute surgical unit (ASU) in July 2011. The ASU is modelled on the concept of acute care surgery (ACS). This study reviews the impact of the ASU on the outcomes in an appendicectomy population.
  
  
  METHODS
  A retrospective review of all patients (aged 16-99 years) who underwent appendicectomies in the 2-year study time frame (from July 2010 to June 2012) at our centre was performed. The cohort (n = 539) was divided into two groups for analysis: the ASU group, patients admitted on or after 18 July 2011 (n = 283), and the control group, patients admitted prior to 18 July 2011 (n = 256).
  
  
  RESULTS
  Median time to operation (1129 min versus 1080 min, P = 0.963) and negative appendicectomy rate (24.2% versus 24.8%, P = 0.871) were similar in both groups. The proportion of operations performed overnight (18.00-08.00 hours) was significantly decreased in the ASU group (17.1% versus 30.7%, P < 0.001). Perforation rate was marginally higher in the ASU group (17.8% versus 11.8%, P = 0.053) but failed to reach statistical significance. There was an increase in the usage of preoperative imaging (40.3% versus 30.5%, P = 0.018) in the ASU group. Operating times, length of stay, laparoscopic-to-open conversion and surgical site infection rates remained similar.
  
  
  CONCLUSIONS
  We conclude that implementation of an ACS model does not lead to objective differences in outcome for patients after appendicectomy. However, the ACS model significantly decreased the number of operations performed after-hours.
authors.affiliation: Department of Upper GI/HPB Surgery, Monash Medical Centre, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia.
authors.forename: Benjamin Ruimin
authors.initials: BR
authors.lastname: Poh
authors.forename: Paul
authors.initials: P
authors.lastname: Cashin
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Dubrava
authors.forename: Stephen
authors.initials: S
authors.lastname: Blamey
authors.forename: Wei Wei
authors.initials: WW
authors.lastname: Yong
authors.forename: Daniel Gerald
authors.initials: DG
authors.lastname: Croagh
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D011183:Postoperative Complications; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D055815:Young Adult
keywords: acute disease; appendectomy; appendicitis; emergency service; general surgery; surgery department